Public Healthcare Organizations Research Articles

Nurses'ways of talking about their experiences of (in)justice in healthcare organizations: Locating the use of language as a means of analysis.

Nurses have their own ways of talking about their experiences of injustice in healthcare organizations. The aim of this article is to describe how nurses talk about their work-life experiences and discuss the discursive effects that arise from nurses'use of language regarding their political agency. To this end, we present the findings garnered from a study focused on exploring how nurses deploy their political agency to project their idea of social and political justice in public healthcare organizations and how they face the challenges and uncertainties of (re)thinking their institutional order when it does not resonate with their professional ethos. We then discuss the implications that nurses'use of language has in relation to their ability to deploy their political agency to oppose the forms of injustice they face in their daily practice. We conclude by stating that careful attention should be placed on understanding the discursive implications of nurses'use of language on their individual and collective emancipation in healthcare organizations.

Dedicated to the 100th anniversary of the birth of professor Valentina Trofimovna Selezneva

The article is devoted to the 100th anniversary of the birth of Selezneva Valentina Trofimovna Doctor of Medical Sciences, professor, teacher, public health organizer, public figure, historian of medicine, Head of the Department of Social Hygiene and Organization of Public Healthcare of the Medicopreventive Faculty of Perm State Medical Academy. In 1947, she graduated with honors from the Sanitary-Hygienic Faculty of Molotov Medical Institute, in 1950 from the postgraduate courses. All her life was connected with Perm Medical Institute. Valentina Trofimovna paid a great attention to students' scientific society. Together with her colleagues, she founded the school "Young Organizer of Healthcare," where from 20 to 30 students were trained every year. Valentina Trofimovna was an active public figure four times she was elected the deputy of the city of Perm in Leninsky District Council; she was the Chairman of the permanent commission on health care and social security. Valentina Trofimovna was interested in the history of medicine in the region. Books on the history and development of Perm Medical University, "From the Medical Faculty to the Medical Academy" and "Essays on the History of Medicine in Perm Province" were published under the guidance of V.T. Selezneva. Under her supervision, nine Ph.D theses, including those on history of medicine were prepared. V.T. Selezneva was awarded the orders, medals and honorary diplomas for her truly selfless work. The article also presents an interview with colleagues, students and postgraduate students, reflecting the memories of Valentina Trofimovna Selezneva as a person and a teacher.

Quality of working life of employees in public healthcare organization in Finland: A cross-sectional study.

Work dissatisfaction, burnout and workforce shortage are major problems in healthcare globally, all of which are associated with QWL. Previous studies have found that the QWL of healthcare professionals is moderate or low. The aim was to describe the quality of working life (QWL) of employees working in public healthcare and describe the association between QWL and background variables. This study had a quantitative cross-sectional survey design. Data was collected from the employees of a Finnish healthcare organization in autumn 2021 using an online questionnaire (n = 837). Convenience sampling was used in the selection of the healthcare organization. The study was reported according to STROBE guidelines. The QWL was moderate, and the mean QWL index calculated from the questionnaire responses was 0.524. The QWL index was lowest in healthcare professionals and highest in upper management, with some dissatisfaction towards leadership noted.

“Look before you leap”: comparing the turnover intention of nurses as public servants and private employees

PurposeIn recent decades, human resource management (HRM) in health organizations has faced several problems associated with employees' efficiency and happiness, which has been particularly exacerbated after the pandemic crisis. In this scenario, this study seeks to analyze nurses' turnover intention by comparing Portuguese public and private healthcare organizations. As determining factors, transformational leadership, perceived organizational support and organizational commitment were considered.Design/methodology/approachA survey was digitally applied to 277 nurses from Portuguese public and private healthcare organizations.FindingsResults suggested that there are differences in nurses' turnover intentions: there is a greater likelihood of nurses in the private sector planning to leave the healthcare organizations the nurses work for when compared to public hospital nurses. Furthermore, nurses in public hospitals perceive lower levels of transformational leadership, organizational support and organizational commitment than those in the private sector. The underlying cause as to the intention of leaving the public sector resides in normative commitment. On the other hand, lower affective commitment explains the intention to abandon the private sector.Practical implicationsThis study is relevant for human resource managers and administrators in public and private hospitals since it enables a diagnosis of the situation, as well as a definition of the most appropriate policies for each of the sectors as a strategy to attract and retain health professionals.Originality/valueThis study is significant as the study provides a better understanding of the reasons which lead nurses to consider leaving the organization where the nurses work and the difference between nursing professionals in public and private hospitals.

Learning from errors in digital patient communication: professionals’ enactment of negative knowledge and digital ignorance in the workplace

PurposeThe purpose of this study is to investigate how professionals learn from varying experiences with errors in health-care digitalization and develop and use negative knowledge and digital ignorance in efforts to improve digitalized health care.Design/methodology/approachA two-year qualitative field study was conducted in the context of a public health-care organization working with digital patient communication. The data consisted of participant observation, semistructured interviews and document data. Inductive coding and a theoretically informed generation of themes were applied.FindingsThe findings show that both health-care and digital communication professionals learn through experiences with digital “rule-” and “knowledge-based” errors in patient communication and develop negative knowledge and awareness of digital ignorance. In their joint efforts, they use negative knowledge to “bend the rules” and to explore digital ignorance in efforts to improve patient communication.Originality/valueThis study provides insight into the importance of collaboration between professionals with varying experience of errors in digitalizing patient communication. Such collaboration is required to acknowledge own shortcomings and create complementary negative knowledge to improve digital patient communication. This is particularly important when working with innovative digitalization in health care.

The Application of Model-Based Systems Engineering to Rural Healthcare System Disaster Planning: A Scoping Review

Disasters and other emergency events have complex effects on human systems, particularly if the events are severe or prolonged. When these types of events happen in rural communities, the resources of the local public health, healthcare, and emergency response organizations can be quickly depleted or overwhelmed. Planning for emergencies can help to mitigate their impact. Model-based systems engineering (MBSE) methods, including computer simulations, can provide insight on how best to prepare for these events and to explore the effects of varying approaches and resource utilization. To best apply these methods for improving disaster management in rural settings, a synthesis of the current body of evidence in this field is needed. The objective of this scoping review was to provide a descriptive overview of the application of computer simulation based on MBSE approaches to disaster preparedness and response for rural healthcare systems. Six studies met inclusion criteria, and varied in terms of MBSE method used, healthcare setting, and disaster type and context considered. We identified a gap in the research regarding the application of MBSE approaches to support rural healthcare disaster preparedness planning efforts. Model-based systems engineering and systems thinking, therefore, represent novel methods for developing tools and computational simulations that could assist rural communities better prepare for disasters.

The role of team compassion in mitigating the impact of hierarchical bullying

Abstract Hierarchical bullying in public healthcare organizations is an entrenched negative behaviour that results in a range of adverse outcomes for staff, including diminished wellbeing. This study integrates social exchange and conservation of resources theories as a lens for formulating hypotheses and employs multilevel statistical modelling to examine whether team-level compassion moderates the impact of hierarchical bullying on wellbeing. Using multilevel statistical modelling, the study analysed cross-sectional data from 632 healthcare workers nested within 48 teams in a single public health district in Australia. The findings indicate that work teams with higher levels of team compassion can mitigate the negative effects of hierarchical bullying on employee wellbeing. The results imply that investing in developing compassion within teams is an effective strategy for mitigating some harmful effects of hierarchical bullying on employee outcomes.

Cultural intelligence and proactive service performance: mediating and moderating role of leader's collaborative nature, cultural training and emotional labor

PurposeDrawing on cultural intelligence and social exchange theories, this study examines cultural intelligence and its effects on proactive service performance and the mediating role of leader's collaborative nature and the moderating role of cultural training and emotional labor, particularly deep acting and surface acting, in the relationship between cultural intelligence and proactive service performance.Design/methodology/approachThe study sample comprised 510 healthcare practitioners. Structural equation modeling was used to examine the hypotheses.FindingsThe results show that cultural intelligence positively influences proactive service performance. Additionally, leadership's collaborative nature influences proactive service performance. The moderating effect of cultural training and deep acting positively influences the relationship between cultural intelligence and proactive service performance. In contrast, surface acting reveals a reverse effect, thus exhibiting a positive effect on this relationship.Research limitations/implicationsThese findings suggest that public healthcare organizations should pay more attention in improving deep acting, cultural training and leadership's collaborative nature for optimal service performance.Originality/valueThe novelty of this study lies in its presentation of an integrated framework based on cultural intelligence and social exchange theories that can solve the contemporary challenges facing healthcare firms operating in emerging markets in integrating cultural intelligence and service performance.

The Risk Mitigation Decision-Making Model for Music Therapy Services During the Covid-19 Pandemic

Abstract When the Covid-19 pandemic began, music therapists moved quickly to adapt services across many clinical settings. Many music therapists shifted their service delivery model to telepractice. Music therapists also worked to adapt in-person services to integrate the emerging risk mitigation strategies required or recommended by various public health bodies and healthcare organizations. When public health circumstances are changing rapidly, how do music therapists make decisions regarding service delivery and risk mitigation, while balancing the requirements of public health directives and organization policies? Considering evidence-based practice and ethical thinking, we propose a risk mitigation decision-making model for providing clinical music therapy services during the Covid-19 pandemic. We consider the intersection of public health guidelines and orders, service delivery options (i.e. telepractice), and risk mitigation strategies for in-person services. Case studies follow, as well as discussion of how to use this model in future public health crises.

Motive, mindset and opportunity: exploring leader ambidexterity factors in health-care

PurposeAmbidexterity increases an organisation’s capability to successfully navigate dynamic and uncertain environments. While leaders are expected to model flexible learning and practices throughout the organisation, little is known about the leader characteristics and contextual factors that underpin ambidexterity. This study aims to explore whether paradoxical thinking, integrator behaviours and managerial role and level influence the likelihood of leaders exhibiting ambidexterity.Design/methodology/approachThis study relied on a self-report questionnaire completed by 152 managers of a large, public health-care organisation in New Zealand. A k-means cluster analysis of the data was conducted to identify leader ambidexterity clusters, and the hypothesised effects were tested with multinomial logistic regressions.FindingsHealth-care managers favoured exploitation and moderate ambidexterity. Higher levels of integrator behaviours (i.e. reflective learning and context responsiveness) were found among leaders who showed high ambidexterity. Context responsiveness was the sole significant predictor distinguishing between high ambidexterity and other ambidexterity profiles. No statistically significant differences in ambidexterity cluster membership were found between clinical and non-clinical roles and across managerial levels.Research limitations/implicationsWhile our study relied on a cross-sectional self-reported design, the findings underscore the importance of learning behaviours and context responsiveness to ambidexterity. This study discusses avenues for future research and leadership development towards improved organisational learning systems and practices.Originality/valueTo the best of the authors’ knowledge, this study is one of the first to test the contribution of paradoxical thinking and integrator behaviours to health-care leader ambidexterity and to examine differences in ambidexterity profiles across managerial levels and roles. The factor analysis suggests that integrator behaviours represent two distinct constructs: reflective le`arning and context responsiveness.

Resource-based View: A new strategic perspective for public health service managers

The resource-based view (RBV) theory is a widely accepted strategic management theory, particularly within private sector organisations. [1,2,3] However, within public healthcare settings, the level of empirical support available on the use and appropriateness of RBV within this environment is largely unchartered. Consequently, this paper aimed to further understand the level of evidence for the purpose of providing an insight into how it may be used to improve the efficiency and effectiveness of public health organisations. An extensive literature search returned a total of 859 studies. Of these, just 13 studies met the inclusion criteria of being an investigation of the use of RBV theory in public sector healthcare organisations. The analysis conducted demonstrates that while the use of RBV theory has been relatively slow, the benefits are positive. The practical application of RBV theory lies in strategically mapping the relationships between resources, capabilities, and public value, relevant to healthcare organisations, in order to gain and understand how public value is created to provide a competitive advantage and superior performance for the organisation.

Aligning goals of for-profit, not-for-profit, and public healthcare organizations by governing for quality: A model for change in the U.S. and other jurisdictions.

There has been widespread criticism of privately owned or operated healthcare organizations in Canada and beyond. However, governments have limited resources to infuse the capital and provide the scale necessary to rapidly address the post-pandemic needs of healthcare systems. Ensuring that healthcare providers regardless of ownership or for-profit or not-for-profit status, provide high quality care and ensure health equity is paramount. Here, we propose the use of a governance for quality model based on the Excellent Care for All Act (2010) developed for public hospitals in Ontario for all healthcare organizations regardless of ownership or profit status, to better align all forms of healthcare providers with quality outcomes and equitable and positive patient experience. We believe that this framework is applicable to healthcare organizations both public and private, for-profit and not-for-profit in Canada, the U.S. and beyond.

LEAN concept - possibilities of implementation and improvement of business processes in public healthcare organizations

Introduction: The basic postulate of the lean concept is that greater efficiency of the work process can be achieved through a process of continuous improvement,which aims to eliminate waste and maximize activities that add value.The Netherlands, Great Britain, Italy and the United States were examples of healthcare systems that implemented the lean concept.Aim: To examine the opinion of health workers of a public hospital in the Sarajevo area about the possibilities of improving business processes by implementing thelean concept.Method: The cross-sectional study was conducted using a questionnaire. The questionnaire was sent to the e-mail addresses of health workers of public health organizations. 91 respondents of both sexes (doctors ofmedicine, residents, registered nurses, nurses and administrative staff) were included.Results: A positive correlation was establishedin the attitude toward the effectiveness and efficiency of business processes. According to the participant’s opinion, the greater effectiveness of business processes contributes to greater efficiency (r=0.846; p<0,05). Spearman’s coefficient rs=0.81 shows a strong connection between the effectiveness and efficiency of business processes.Conclusion: The study showed that there is a positive attitude towards the impact of the lean concept on improving the efficiency of business processes. The reducexpected positive effects of the implementation of the lean concept are manifested through faster provision of services to patients, reduction of service waiting times and general improvement of business processes.

Early unplanned return visits to pediatric emergency departments in Israel during the SARS-CoV-2 pandemic

IntroductionDuring the SARS-CoV-2 pandemic there was a considerable drop in the number of visits to Pediatric Emergency Departments (PED). Unplanned return visits (URV) might represent inadequate emergency care. We assessed the impact of the pandemic on early URV to PEDs in Israel. MethodsThis multicenter cross-sectional study analyzed the 72-h URV to PEDs among patients under the age of 18 years during a one-year pandemic period (March 1st, 2020, to February 28th, 2021), and compared them with the 72-h URV of the corresponding pre-pandemic period (March 1st, 2019, to February 28th, 2020). Data was extracted from Clalit Health Services (CHS), the largest public health care organization in Israel. ResultsThe pandemic and pre-pandemic early URV rates were 5465 (5.1%) and 8775 (5.6%), respectively (OR = 0.90, 95% CI 0.92–0.99). The rate of return-visit admissions to hospital wards during these periods were 29.5% and 32.1%, respectively (OR = 0.83, 95% CI 0.86–0.98). The rate of return-visit admissions to ICUs during these periods were 0.64% and 0.52%, respectively (OR = 1.11, 95% CI 0.67–1.62). On return-visit, 3 (0.055%) and 5 (0.057%) URV patients were declared dead on arrival during the pandemic and pre-pandemic periods, respectively (OR = 0.96, 95% CI 0.23–4.03). The distributions of the time interval from index visit to return visit remained consistent between the periods. DiscussionIn our study, early URV to PED's were only mildly influenced by the SARS-CoV-2 pandemic.

Enhancing the nation's public health information infrastructure: a report from the ACMI symposium.

The COVID-19 pandemic exposed multiple weaknesses in the nation's public health system. Therefore, the American College of Medical Informatics selected "Rebuilding the Nation's Public Health Informatics Infrastructure" as the theme for its annual symposium. Experts in biomedical informatics and public health discussed strategies to strengthen the US public health information infrastructure through policy, education, research, and development. This article summarizes policy recommendations for the biomedical informatics community postpandemic. First, the nation must perceive the health data infrastructure to be a matter of national security. The nation must further invest significantly more in its health data infrastructure. Investments should include the education and training of the public health workforce as informaticians in this domain are currently limited. Finally, investments should strengthen and expand health data utilities that increasingly play a critical role in exchanging information across public health and healthcare organizations.

Socioeconomic Determinants of Life Expectancy: Southeastern European Countries

This paper analyses the socioeconomic determinants of life expectancy in Southeastern Europe countries highlighting the most important factors that can affect life expectancy in this part of Europe. 
 Two Panel Data Regression with fixed–effects model was applied for 20 years from 2000 to 2019. Eight socioeconomic and environmental explanatory variables were used to verify their influence on life expectancy.
 The analysis highlights the important influence of factors such as urbanization; GDP per capita; fertility rate; education; marital status; CO2 emission and the non-significant influence of other factors, such as health expenditure or health care out-of-pocket healthcare expenditure. This study points out that healthcare spending (public and/or household out-of-pocket spending) is not a significant factor in improving life expectancy in SEE countries. Results illustrate that GDP per capita; urbanization, CO2 emissions, and fertility rate are the most influential and significant explanatory factors. A surprising result concerns marital status, which in this study affects life expectancy inversely in one of the panel regressions.
 Life expectancy is a very important and expressive outcome indicator for public health. Each country is committed to spending public money to improve people's quality of life, which translates into a longer life (Life expectancy), or even better, a longer and healthier life (Health Adjusted Life Expectancy). The results of this study, considering the demographic development of the SEE countries (low fertility rate and aged people), show that policymakers need to consider public healthcare organization and reassess the effectiveness of public health expenditure. On the other hand, the balanced urbanization process with a clean ecosystem (less CO2 emissions) conducts a better life quality (consequently an improved life expectancy).
 Keywords: Panel data analysis; Life Expectancy; Public Health; SEE Countries
 Jel Classification: C33; H51; I15

Security and Usability of a Personalized User Authentication Paradigm: Insights from a Longitudinal Study with Three Healthcare Organizations

This article proposes a user-adaptable and personalized authentication paradigm for healthcare organizations, which anticipates to seamlessly reflect patients’ episodic and autobiographical memories to graphical and textual passwords aiming to improve the security strength of user-selected passwords and provide a positive user experience. We report on a longitudinal study that spanned over 3 years in which three public European healthcare organizations participated to design and evaluate the aforementioned paradigm. Three studies were conducted ( n = 169) with different stakeholders: (1) a verification study aiming to identify existing authentication practices of the three healthcare organizations with diverse stakeholders ( n = 9), (2) a patient-centric feasibility study during which users interacted with the proposed authentication system ( n = 68), and (3) a human guessing attack study focusing on vulnerabilities among people sharing common experiences within location-aware images used for graphical passwords ( n = 92). Results revealed that the suggested paradigm scored high with regard to users’ likeability, perceived security, usability, and trust, but more importantly it assists the creation of more secure passwords. On the downside, the suggested paradigm introduces password guessing vulnerabilities by individuals sharing common experiences with the end users. Findings are expected to scaffold the design of more patient-centric knowledge-based authentication mechanisms within today's dynamic computation realms.

Is it possible to achieve a "fit" of management control practices and strategies in Indonesia's reformed public hospitals?

Research aims: This research aims to investigate the effectiveness of implementing management control practices (MPCs) and examine whether MPC is possible and how MPCs as a package "fit” with the strategic choices of Local Community Service Agency (BLUD) public hospitals (PHs) in Indonesia.Design/Methodology/Approach: This study applied mixed-method research with a sequential explanatory strategy. Quantitative data were collected through self-administered questionnaires distributed to 29 top management team members of eight BLUD PHs in East Java and Bali, Indonesia. Meanwhile, qualitative data were generated by conducting a semi-structured interview with four selected top management team members of BLUD PHs. The data were then analyzed quantitatively and qualitatively by implementing profile deviation analysis, cluster analysis, ordinal regression analysis, and content analysis.Research findings: Quantitatively, the researchers found a negative correlation, yet insignificant, between the “misfit” of MCPs and strategy and management control effectiveness. Thus, the “fit” hypothesis was not supported. Qualitatively, the researchers revealed that BLUD PHs extensively used MCPs and employed them in various ways, including cultural, administrative, and dominantly cybernetic controls. Finally, it can be concluded that using cybernetic controls as a dominant practice is unsuitable for the strategy chosen by BLUD PHs in Indonesia.Practical and Theoretical contribution/Originality: This study expands upon what has already been explored in the management control literature concerning how MCPs might be configured to align with organizational strategy, especially in the context of public healthcare organizations. Practically, the reformed PHs in Indonesia are expected to understand better the structure and characteristics of the BLUD-based financial management environment. It is essential for organizations, as it helps them figure out exactly how their management control practices and organizational strategies fit together.Research limitation: Due to the low questionnaire and interview participation, mixed-methods research was underutilized in this study.

Sickness absence among employees of healthcare organizations in the public sector in Mongolia: A cross-sectional study.

This study aimed to understand the rate of sickness absence (SA) among employees of public healthcare organizations in Mongolia, to identify factors associated with long-term SA, and to estimate costs due to SA. This cross-sectional study included employees of public healthcare organizations who had certified SA from 2016 to 2018. Sociodemographic and occupational characteristics of absentees and the data on absences were collected. A logistic regression analysis was performed to identify factors associated with long-term SA (≥15 days) among employees who had SA. Absence parameters and the average costs due to SA were calculated and the total cost due to SA at all public healthcare organizations was estimated. From 2016 to 2018, there were 13 653 absentees and 21 043 SA, and the absence rate was 0.9%. The average absence length per absence and absentee were 9.63 days and 14.85 days, respectively. Factors associated with long-term SA were age ≥40 years, 10-19 years in employment, working at the second and tertiary levels, and night shift. The average cost per absentee was 295.5 USD, and the estimated total cost for all health organizations was 1 796 993 USD per year. The absence rate was 0.9% and older age, longer work experience, higher organizational level, and night shift were associated with taking a long-term SA. To reduce the costs of absenteeism and promote the health of employees in healthcare organizations, policymakers should review the policies related to SA and develop national guidelines on SA for employers, healthcare managers, and employees.

Impact of Green Human Resource Management on Sustainable Performance

The major purpose of Green Human Resource Management is to create a workforce that recognizes, values, and implements green ideas while upholding the company's green goal in the Human Resource Management practice of hiring, selecting, training, developing, rewarding, and promoting the human capital of the company. Two key elements of green HR are the protection of intellectual capital and eco-friendly Human Resource practices. Numerous academics have examined the value of green HRM in fostering an environmentally conscious mindset among employees, although this area of study is still in its infancy. Businesses now place a higher priority on environmental management and green management, and they have aligned their goals and tactics to reflect this. As a result of the realities of corporate globalization, the economy has changed from a traditional banking and economic structure to a more modern, capacity-based one. In other words, it takes both environmental economics and environmental management into account. Green human resource management, which has received a lot of attention in corporate organizations, may be used effectively to maintain green workplaces and green practices, which will help to green organizational culture. For businesses to achieve their environmental objectives, such as going green, green HRM is a crucial strategic tool. The results of this study indicate that practices like green hiring have an impact on the sustainable performance of both public and commercial healthcare organizations. Data were acquired using a quantitative research approach. 200 persons, including representatives of both public and private healthcare services, participated in the survey. Partial least squares-structural equation modelling was used to analyze the data. Hiring green candidates benefits the performance of the environment, the economy, and society as a whole. This research benefits organizations by assisting them in applying GHRM techniques that support organizations in every way. Additionally, this research will be helpful to policymakers because it will provide them a better understanding of how to promote GHRM practices and improve organizational sustainability.